Falling short in labeling seniors

I'm confident I'm not the only person who has worked in a hospital or long-term care who has heard this conversation about someone elderly who has recently died.

“Well, she fell and broke her hip a few months ago,” Person A says. Person B shakes her head and says, “Well, after that, it's all downhill.”

While it sounds flip, there's data to back up what many of you know from anecdotal evidence: Falls are the leading cause of fatal and non-fatal injury among older adults, and more than 95% of hip fractures are caused by falls, according to the Center for Disease Control and Prevention. Additionally, those who fall after age 75 are up to five times more likely than those 10 years younger to be in a long-term care facility for a year or more.

So it's no surprise treating falls is expensive — by 2020, the annual direct and indirect cost of fall injuries is expected to reach $67.7 billion — and is a hot topic in research for the federal government and states.

That's why it was interesting to read a certain abstract from Jennifer Sabel, Ph.D., an injury and violence prevention epidemiologist at the Washington State Department of Health. She conducted an analysis to understand how adults who are hospitalized for a fall vary in characteristics from those held in observation status. In Washington between 2010 and 2012, there was a 25% increase in the age-adjusted rate of observation stays among older adults with a primary diagnosis of an unintentional fall. Sabel is scheduled to present on her research at the CSTE (Council of State and Territorial Epidemiologists) conference next month.

What she found was that there were nearly 30,000 hospitalizations and 4,223 observation stays with an unintentional fall as the primary diagnosis. Those in the hospital were more likely to have a hip fracture diagnosis and a longer length of stay, and were more likely to be discharged to a skilled nursing facility compared to those in observation. How you feel about the latter fact may depend on whether you believe your facility can provide the rehabilitation and care to have a skilled nursing resident get back on his or her feet, and whether, as many have argued, seniors are inappropriately being listed as under observation and then denied SNF coverage that they need. States need to be comparing apples to apples when looking at the costs and course of treatment for falls.

“The goal was to see whether we should be including hospitalizations and observation stays separately when dealing with unintentional falls,” Sabel told me. “Those who were hospitalized were more likely to have a hip fracture, and those hospitalized stay longer. Those in observation seem to be going home more frequently. I want to keep looking at it. There are a minority of people in observation stays who are similar to those hospitalized with similar symptoms, and people who do end up transferring [to skilled care] does lead to the question of whether they were given the right status.”

While more research is needed, and Sabel says she can't say for certain, “there are a minority of older adults in observation stays who are similar to those hospitalized with similar symptoms, and the people who do end up transferring [to skilled care] does lead to the question of whether they were given the right status.”

No matter which side people fall on with regards to the observation stay debate, Sabel's research does lend credence to how state departments of health, hospitals and long-term care providers need more research in how specific populations are labeled. Part of this may be attending a conference like CTSE, traditionally not a place you'll find a lot of long-term care folk. But as healthcare delivery continues to evolve, breaking down silos doesn't just mean working with a hospital: It means staying abreast of the knowledge from epidemiologists and other researchers on topics such as falls.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.